Case reportClinical, neuropathological and radiological evidence for a rare complication of rituximab therapy
Introduction
Anti CD 20 therapy may result in unusual infections with atypical presentations, posing diagnostic difficulties. We highlight the long term immunomodulatory effects of rituximab by reporting the rare complication of myofasciitis, with clear documentation of the pathology of enterovirus myofasciitis for the first time.
Section snippets
Case report
A 36-year-old man was treated four years into his diagnosis of a grade 1 follicular lymphoma, with six cycles of R-CHOP chemotherapy. He achieved a complete metabolic remission on re-staging positron emission tomography (PET) scanning. Chemotherapy was complicated by two episodes of neutropenic sepsis and mild iatrogenic deafness with vestibular failure from aminoglycoside use. One year following treatment, whilst on maintenance therapy with rituximab for three months, he developed myalgia,
Discussion
Chronic ‘myositis’ and meningitis due to echovirus infection is documented in patients with primary immunoglobulin deficiencies [1], [2], [3]. A number of enteroviral strains have been isolated from the CSF but not in muscle, as in this case. It is hypothesised that the role of enteroviruses in the pathogenesis of inflammatory muscle disease may be related to pathways of autoimmunity following acute infection, without persisting viral replication. Many early cases have been described to have an
Acknowledgments
We thank Dr Tim Diss, Clinical Scientist at University College Hospital London for PCR analysis and Dr Zane Jaunmuktane, Specialty Registrar in Neuropathology, Division of Neuropathology, National Hospital for Neurology and Neurosurgery, for slide scanning and image preparation. We thank the UCLH/UCL CBRC for their support.
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